naa a22 4500 510814190 CHVBK 20180411083457.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12328-013-0400-3 doi (NATIONALLICENCE)springer-10.1007/s12328-013-0400-3 Septic pulmonary embolism originated from subcutaneous abscess after living donor liver transplantation: a pitfall of postoperative management [Elektronische Daten] [Kazuhisa Takeda, Kuniya Tanaka, Takafumi Kumamoto, Kazunori Nojiri, Ryutaro Mori, Koichi Taniguchi, Ryusei Matsuyama, Hideaki Kato, Itaru Endo] The use of immunosuppressants after liver transplantation (LT) is associated with postoperative complications, including infections. A 49-year-old male underwent living-donor (LD) LT because of primary sclerosing cholangitis. He was treated with tacrolimus, mycophenolate mofetil, and steroids as immunosuppressants, discharged on postoperative day (POD) 40, and re-admitted because of severe acute cellular rejection on POD 48. Three courses of steroid pulse therapy were performed, and continuous peripheral intravenous drip infusion therapy via the left forearm was necessary for 20days because of appetite loss. The patient was discharged on POD 83, but re-admitted on POD 87 with pyrexia. A subcutaneous abscess was present at a puncture wound on the left forearm formed by an intravenous drip during the last hospital stay. Furthermore, computed tomography showed five pieces of cavitary or wedge-shaped nodules in the bilateral lung. Because sputum revealed the presence of Gram-positive coccus, and subcutaneous abscess and blood cultures revealed Staphylococcus aureus, the pathogenesis was septic pulmonary embolism (SPE) secondary to S. aureus septicemia originating from a subcutaneous abscess formed by an intravenous drip. The patient was treated with drainage of the subcutaneous abscess and antibiotic therapy, and recovered immediately. Although there have been few reports of SPE after LDLT, SPE is fatal in up to 13.3% of patients. Early diagnosis, drainage of the infectious source, and appropriate use of antimicrobial therapy should be necessary to overcome SPE. Furthermore, the identical intravenous catheters should be removed whenever possible to avoid infectious complications including SPE for patients who receive steroid pulse therapy after LDLT. The Author(s), 2013 Septic pulmonary embolism nationallicence Living donor liver transplantation nationallicence Steroid pulse therapy nationallicence LT : Liver transplantation nationallicence LD : Living donor nationallicence POD : Postoperative day nationallicence SPE : Septic pulmonary embolism nationallicence CRP : C-reactive protein nationallicence ALT : Alanine aminotransferase nationallicence CT : Computed tomography nationallicence MRSA : Methicillin-resistant Staphylococcus aureus nationallicence Takeda Kazuhisa Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Tanaka Kuniya Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Kumamoto Takafumi Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Nojiri Kazunori Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Mori Ryutaro Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Taniguchi Koichi Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Matsuyama Ryusei Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Kato Hideaki Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan aut Endo Itaru Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut Clinical Journal of Gastroenterology Springer Japan 6/5(2013-10-01), 378-382 1865-7257 6:5<378 2013 6 12328 https://doi.org/10.1007/s12328-013-0400-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12328-013-0400-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Takeda Kazuhisa Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Tanaka Kuniya Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Kumamoto Takafumi Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Nojiri Kazunori Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Mori Ryutaro Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Taniguchi Koichi Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Matsuyama Ryusei Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 700 1- Kato Hideaki Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan aut NATIONALLICENCE 700 1- Endo Itaru Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan aut NATIONALLICENCE 773 0- Clinical Journal of Gastroenterology Springer Japan 6/5(2013-10-01), 378-382 1865-7257 6:5<378 2013 6 12328 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer